Pharmacists do much more than simply filling out prescriptions; aside from carrying out research on drugs, they are also crucial in patient education on disease prevention and medication usage. Priya Kulasagaran learns more about the work and challenges of pharmacists at the Malaysian Pharmaceutical Society’s 50th anniversary celebration
Many people have the misconception that pharmacists are only there to dole out their medications for them, a rather outdated idea borne from the pharmacists of yesteryear being mostly in the back rooms of clinics and hospitals dutifully checking and stocking prescription drugs. For some time now however, pharmacists have moved beyond simply being product-orientated to helping the healthcare sector as a whole, deliver quality patient care. “Today, pharmacists are an integral part of the healthcare team, and play an active role in delivering evidence-based practice, ensuring patient monitoring and safety,” said the Health Ministry’s Research and Technical Support deputy director general Datuk Dr Shahnaz Murad.
Dr Shahnaz was speaking during the launch of the Malaysian Pharmaceutical Society’s (MPS) 50th anniversary celebrations recently. Themed “My Society, My Passion”, the event also coincided with the society’s annual seminar and saw some 600 pharmacists in attendance.
Meanwhile, MPS president Amrahi Buang shared the ways in which the society has championed healthcare reforms over the years. “In 1995, we signed the patient charter with the Malaysian Medical Association, the Malaysian Dental Association, and the Federation of Malaysian Consumer Associations (Fomca), as we recognised that medication safety and patient safety needed to be prioritised. We successfully petitioned the government in 2015 to approve zero rated Goods and Services Tax (GST) for scheduled poisons to ensure the rakyat was not burdened by GST imposed on scheduled poisons,” he said, adding that the MPS was working with other stakeholders to expand the list of medications listed on the National Essential Medicine list to help consumers deal with the financial burden of healthcare.
One of the major causes the MPS is currently championing is one that could change the way we receive our medications -– the fight for dispensing separation.
Who should dispense medications?
If you have dropped by the neighbourhood clinic to get some medication for your flu, this is likely the common scenario: you wait to see the doctor, get your check-up done, the doctor gives you a diagnosis, you get your medication at the counter and go home. Some argue that this system is flawed, and that you should be getting your prescription filled by a qualified pharmacist rather than straight from the doctor.
Enter dispensing separation, where there is a clear distinction between the prescribing and dispensing of medicine. Advocates of this approach say that it is important to have doctors who provide the medical prescription to be independent of the pharmacist who provides the prescribed drugs. While dispensing separation is the norm in many Western countries, the issue is a contentious one in Asia, and in Malaysia in particular. While local government hospitals and clinics have had this separation in place for decades, this has not been the case with private practitioners.
Critics of this dispensing separation have noted that healthcare costs could rise if the practice is put in place, as you would be adding another layer between the consumer and their required medicine. But the MPS’ stand is that dispensing separation would provide an extra level of care, both as a check and balance for prescriptions, as well as greater patient education.
“According to the National Survey on the Use of Medicines by Malaysian Consumers 2012, the findings showed that 56% of consumers do not understand the proper use of their medicines, 51% are unaware of their trade name and 56% are not aware of common side-effects,” said Amrahi. “This is not about pharmacists or us overtaking the role of doctors; our main concern is patient safety. We want best practices in place, so patients can benefit from both competent doctors and pharmacists.”
Addressing the issue of inconvenience to patients as well as an increase in healthcare costs, MPS vice president Bharati Suresh Chand stressed the need to look at the bigger picture rather than just short-term challenges. “I believe when consumers see the value of professional pharmacists, they will find it worth the time and cost. When you’re sent to a pharmacist, you’ll be given proper consultation, advised on the proper use of medications and how to store them. Research in other countries have shown that with pharmacists playing their role, more patients took their medication on time and hospitalisation time was reduced – in this way, we actually see a total cost reduction in the long-run,” she said.
Offering a view beyond local shores was Federation of Asian Pharmaceutical Associations (FAPA) president Joseph Wang, who reiterated the need for patient safety to be at the forefront of discussing dispensing separation. “Patient safety is the responsibility of both physicians and pharmacists, we need to work together. Many countries such as Thailand have even increased their pharmacy education from four to six years; this is because knowledge on the usage of different types of medications has increased, and pharmacists are starting to specialise in certain areas such as diabetes management,” he said. He added that the FAPA had co-hosted a stakeholders forum with MPS on the matter, and found that consumers were receptive to exploring the role of dispensing separation in improving patient care.
Shortage or surplus?
Currently, Malaysia produces around 1,300 pharmacists every year, while the recommended World Health Organization ratio of pharmacist to patient for developed countries is set at 1:2,000. According to Amrahi, Malaysia’s ratio stands at 1:2,837, and 59% of registered pharmacists are in the public sector. It may sound strange then that the MPS last year called for a five-year moratorium on pharmacy courses locally. However Amrahi explained that numbers alone fail to paint the full complicated picture.
“At the moment we have 21 schools offering 27 pharmacy courses in the country; five are public tertiary institutions, while the rest are private ones,” he said. “The suggested moratorium is not about controlling the number of pharmacists, but about looking at the country’s needs as well as the issue of quality. We need to have a national policy of looking at the number of pharmacists we need, as well as maintaining the quality of programmes; for example, are there enough qualified academic staff to cater to all these students?”
He added that the availability of training posts should be considered before churning out thousands of pharmacy graduates. “A graduate needs to undergo a one-year Provisionally Registered Pharmacist (PRP) training before he or she can be registered and practice as a Fully Registered Pharmacist (FRP) – and we do not have enough places available for this training,” he said.
“It’s not just about graduates having problems with placement, but also the way we look at the overall number of pharmacists,” adds Bharati. “Are we just looking at the total number of pharmacists in Malaysia against the overall population, or are we looking at just practising pharmacists in communities? If it’s the latter, we have around 4,000 pharmacists to a population of 30 million. It’s also not just about churning out pharmcists, but also looking at the needs of the community, as well as ensuring the quality of the pharmacists themselves.”